| NPI | 1942632500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY LYNN SEAGRAVES Clinical Supervisor 208-287-5624 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2024-07-19 |